Hypovolemia-induced severe coronary spasm leading to acute myocardial infarction

Acute ST-elevation myocardial infarction (STEMI) is a well recognized manifestation of severe coronary artery spasm. Although there are many recognized triggers, hypovolemia has not been previously described. The present report describes a case of acute STEMI that occurred four days following major colonic surgery in a severely dehydrated patient. Coronary angiography revealed underfilled coronary arteries with severe multifocal spasm, which largely resolved with aggressive fluid repletion and intracoronary nitrate.